The Study of Type of Frequent Attenders among Outpatients Care under National Health Insurance in Taiwan

[[abstract]]Background: Since the medical system in Taiwan is more unique than that in other countries, people in Taiwan have more rights over choosing their own medical care providers. Besides, with the immaturity of both the family physician system and the referral system in Taiwan, this unique system is characterized by the large average number of outpatient visits, the high rate of hospital attendance (especially the medical center attendance), and the high frequency of changing physicians and health care facilities. In this context, the issue of frequent attenders (FAs) of outpatient services deserves the concern of relevant healthcare competent authorities. Purposes: This study divided FAs of outpatients services into four categories by the number of health care facilities and outpatient specialties, which were FAs who had consulted more facilities and more specialties (MFMS), FAs who had consulted more facilities and less specialties (MFLS), FAs who had consulted less facilities and more specialties (LFMS), and FAs who had consulted less facilities and less specialties (LFLS), to analyze the influencing factors of these four categories of FAs, the number of outpatient visits and outpatient medical expenses in these categories of FAs. With the same calculation base for foreign FAs, this study is designed to examine the hospital attendance of domestic FAs. In addition, the study findings hopefully can serve as references for relevant healthcare competent authorities to develop policies or provide counseling services. Methods: According to the definition of this study, frequent attenders (FAs) refer to patients who have 150 times of outpatient visits or more per year. The research resources of this study originated from the CD files, ID files, and HOSB files of academic database of Taiwan?s National Health Insurance in the National Health Research Institutes (NHRI) in 2006 and 2007. The data obtained from NHRI were processed by the statistical software SPSS 12.0 for descriptive and inferential statistical analyses. Results and Conclusions: 1. Based on the same calculation basis for other countries, the average number of outpatient visits of per FA per year decreased from 179.61 times to 166.15 times. 2. The influencing factors of FA?s number of visits in health care facilities were gender, age, insurance type, insurance area, major illness and injury, mental disorder, and the number of chronic diseases. 3. The influencing factors of FA?s number of visits in specialties were gender, age, insurance type, insurance area, major illness and injury, the number of chronic diseases, and mental disorder. 4. The properties of the four categories of FAs: In comparison with LFLE FAs, influencing factors such as age, insurance area, insurance type, mental disorder, major illness and injury, and the number of chronic diseases could more effectively predict MFLS FAs and LFMS FAs while influencing factors such as gender, age, insurance area, insurance type, mental disorder, and the number of chronic diseases could more effectively predict MFMS FAs. 5. The number of outpatient visits of MFMS FAs was greater than FAs in the other three categories. The medical expenses of LFMS FAs were the highest, followed by those of MFMS FAs, and the medical expenses of MFLS FAs were the lowest. Recommendations: According to the study findings, the following recommendations are proposed for the consideration of relevant healthcare competent authorities: In the aspect of policy-making, it is recommended to 1. adjust the calculation basis for the number of outpatient visits; 2. put joint consultation system into practice; 3. include the counseling operation into the ?Family Physician Integration Trial Plan (FPITP)?. In the aspect of counseling, it is recommended to apply different counseling methods to different categories of FAs according to their respective properties